Citation Nr: 1305419 Decision Date: 02/14/13 Archive Date: 02/21/13 DOCKET NO. 10-42 068 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUES 1. Entitlement to service connection for bilateral upper extremity peripheral neuropathy. 2. Entitlement to service connection for bilateral lower extremity peripheral neuropathy. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD K. J. Kunz, Counsel INTRODUCTION The Veteran served on active duty from August 1958 to August 1978. This appeal comes before the Board of Veterans' Appeals (Board) from a December 2009 rating decision by the Wichita, Kansas Regional Office (RO) of the United States Department of Veterans Affairs (VA). In that decision, the RO denied service connection for bilateral upper extremity peripheral neuropathy and bilateral lower extremity peripheral neuropathy. In October 2011, the Veteran had a Travel Board hearing before the undersigned Veterans Law Judge. The Board has not only reviewed the Veteran's physical claims file, but also the Veteran's file on the Virtual VA electronic file system, to ensure a total review of the evidence. FINDINGS OF FACT 1. Bilateral upper extremity peripheral neuropathy developed as a result of type II diabetes mellitus. 2. Bilateral lower extremity peripheral neuropathy developed as a result of type II diabetes mellitus. CONCLUSIONS OF LAW 1. Bilateral upper extremity peripheral neuropathy is the result of service-connected diabetes. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2012). 2. Bilateral lower extremity peripheral neuropathy is the result of service-connected diabetes. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran contends that he has bilateral upper extremity peripheral neuropathy and bilateral lower extremity peripheral neuropathy that are secondary to or the result of his diabetes. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). In addition, any increase in severity of a non-service-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the non-service-connected disability, will be service connected. 38 C.F.R. § 3.310(b). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran's service medical records do not show diagnosis of diabetes or peripheral neuropathy during service. The claims file contains some records of post-service private and VA medical treatment of the Veteran. Private treatment notes from October 1993 reflect the Veteran's report that clinicians had told him that he was borderline diabetic. In December 1997, a private nephrologist informed the Veteran that he had elevated glucose, and that this could be a warning sign for diabetes mellitus. In November 2002, private primary care physician M. A. L., M.D., wrote that he had treated the Veteran since July 1999. Dr. L. stated that on the Veteran's initial visit he had elevated blood sugars. Dr. L. reported that the Veteran was actually diagnosed with type II diabetes mellitus in November 2000. Dr. L. indicated that he continued to treat the Veteran for diabetes. In a December 2002 VA diabetes examination, the examiner noted Dr. L.'s report of the 2000 diagnosis of diabetes. The Veteran reported that in the late 1970s clinicians told him that he had borderline diabetes, and that he should manage his diet and exercise to control it. The Veteran reported that he experienced diabetes symptoms such as polydipsia, polyuria, and blurred vision before he was diagnosed with diabetes in 2000. At the time of the December 2002 VA examination, the Veteran was on oral medication to treat diabetes. On that examination, neurological examination was within normal limits, providing evidence against this claim. In February 2009, Dr. L. referred the Veteran for neurological testing for suspected peripheral polyneuropathy. Testing revealed bilateral carpal tunnel syndrome and mild underlying peripheral neuropathy in both upper and both lower extremities, providing some evidence in support of this claim. The report of a November 2009 VA examination indicates that beginning around 1980 the Veteran experienced numbness and tingling in both hands and both feet. It was indicated that the Veteran did not seek medical attention for those symptoms until about 2007. It was reported that the Veteran was diagnosed with diabetes in 2000. The examination report contained the history that the Veteran had consumed one beer per day for the last forty years. The examiner found evidence of decreased sensation to light touch in the fingers of both hands and the toes of both feet. The examiner provided the opinion that it is less likely than not that the Veteran's peripheral neuropathy was caused by his diabetes. The examiner explained that the Veteran's peripheral neuropathy manifested before his diabetes was diagnosed. The examiner stated that the Veteran's long history of alcohol use and his obesity were the most likely etiology of his peripheral neuropathy, providing highly probative evidence against these claims. In December 2009, Dr. L. wrote that when the Veteran began in treatment with him around 2000, the Veteran mentioned having tingling in his hands and feet that had arisen within the previous ten years. Dr. L. stated that when he began treating the Veteran the Veteran reported that his previous physician had told him that his blood sugars were running high. The previous physician did not diagnose diabetes, but Dr. L. reported that he soon diagnosed the Veteran's type II diabetes. Dr. L. stated that he was fairly sure that the Veteran's diabetes had been a problem for a while. Dr. L. noted that he started the Veteran on a combination medication, and that such treatment is usually only used when sugars are running high. Dr. L. wrote that he was convinced that the Veteran had diabetes before it was formally diagnosed in 2000. Dr. L. stated that he also was fairly certain that the Veteran's upper and lower extremity neuropathy is a consequence of his diabetes. Dr. L. related that he did not find evidence of other causes of that neuropathy. In the October 2011 Board hearing, the Veteran stated that from as early as the 1970s clinicians told him that his blood sugars were borderline high. In the late 1970s, he related, one doctor told him that there was no such thing as borderline diabetes, that the Veteran had diabetes. He stated that he was formally diagnosed with diabetes in 2000 when Dr. L. performed a test. The Veteran indicated that he later underwent neurological testing which showed carpal tunnel syndrome and peripheral neuropathy. The Veteran stated during his November 2009 VA examination communication was difficult, as the examiner had a strong accent. He stated that the examiner asked him to try to recall whether he had numbness and tingling in his hands and feet in the 1970s or 1980s. He reported that the examiner asked about his alcohol use, and that he indicated that he consumed one beer once in a week to ten days. He stated that the examiner probed as to whether he consumed more than that. The Veteran contends that the peripheral neuropathy in his extremities is a result of his diabetes. His treating physician, Dr. L., supports that view. The VA clinician who examined the Veteran in 2009 opined that the Veteran's peripheral neuropathy is more likely attributable to his alcohol use and obesity than to his diabetes. There is considerable evidence that the Veteran had signs of diabetes or development toward diabetes before his diabetes was diagnosed. His peripheral neuropathy was diagnosed after his diabetes was diagnosed. It is far from clear that his diabetes developed after his peripheral neuropathy developed. Dr. L. and the VA examiner are each competent to provide medical opinions. The opinion of the Veteran's treating physician Dr. L. is at least as persuasive as that of the VA examiner. Overall, the evidence that the Veteran's peripheral neuropathy is proximately due to or the result of his diabetes is at least balanced with the evidence against such a finding. The Board resolves reasonable doubt in the Veteran's favor, and grants service connection for peripheral neuropathy of the bilateral upper extremities and bilateral lower extremities. The nature and, most importantly, extent of the Veteran's problem associated with his diabetes is not before the Board at this time. However, any problems the Veteran has with either alcohol use and/or obesity should not be taken into consideration in these evaluations. ORDER Entitlement to service connection for bilateral upper extremity peripheral neuropathy is granted. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is granted. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs